WHO – Meeting of the Strategic Advisory Group of Experts on immunization, October 2017 – conclusions and recommendations

Milestones :: Perspectives
Editor’s Note:
   The SAGE meeting in October 2017 included a number of important reports and addressed a wide range of issues as detailed in the Final Agenda and supported by meeting documentation.         
   The full meeting report in the Weekly Epidemiological Record is referenced below and we encourage readers to engage it. We elected to provide the report’s full text on a key agenda element – the progress report on the Global Vaccine Action Plan [GVAP] and the proposed immunization indictors for the Sustainable Development Goals [SDGs/Agenda 2030].
WHO – Meeting of the Strategic Advisory Group of Experts on immunization, October 2017 – conclusions and recommendations
Weekly Epidemiological Record, 1 December 2017, vol. 92, 48 (pp. 729–748)
Global Vaccine Action Plan (GVAP): progress report
SAGE reviewed the draft assessment report and recommendations by the Decade of Vaccines (DoV) Working Group and noted that in 2016, while some progress was made towards the goals set out in the GVAP,9 multiple issues at many levels threaten progress, and have the potential to reverse hard-won gains; these include global economic uncertainty, conflicts and natural disasters, displacement and migration, and infectious disease outbreaks.

Moreover, SAGE noted concerning signs of complacency and inadequate political commitment to immunization, as well as limited global appreciation of its power to achieve wider health and development objectives. Additional risks identified include growing levels of vaccine hesitancy, the worrying rise in vaccine stock-outs disrupting access to vaccines, and the continued under-performance of certain countries (the “outlier countries”) relative to others within their region.10

In order to address the situation and to accelerate progress towards attaining the GVAP goals, SAGE issued 12 recommendations:

Broadening the dialogue: The entire immunization community should ensure that immunization is fully aligned and integrated with global health and development agendas – including global health security and the International Health Regulations, health systems strengthening and universal health coverage, and the battle against antimicrobial resistance – and that dialogue is strengthened with additional constituencies such as the business and financial sectors.

Subsidiary recommendation: 1b. Joint External Evaluations: An assessment should be made of immunization-related inputs into national Joint External Evaluations for the International Health Regulations, in order to review the references made to immunization in the evaluations and resulting national action plans.

Funding transitions: Until polio eradication is achieved, financial and technical support provided through the Global Polio Eradication Initiative, GAVI and WHO support should be maintained in at least the 16 polio priority countries in order to ensure the success of eradication efforts and to mitigate the risks to infectious disease surveillance, routine immunization and global health security more generally.

Polio and communicable disease surveillance: Poliomyelitis laboratory and epidemiological surveillance capacities should be maintained in countries across all WHO Regions throughout and beyond the polio endgame and certification process, and built upon to strengthen communicable disease surveillance systems, especially for measles and rubella, and other vaccine-preventable diseases.

Outlier countries: Comprehensive multidimensional assessments should be undertaken in countries experiencing the greatest difficulties in achieving GVAP goals and used to develop bespoke and costed remediation plans addressing systemic weaknesses, integrating existing improvement plans and including a strong focus on monitoring and evaluation frameworks to support effective implementation.

Maternal and neonatal tetanus: Concerted efforts should be made to achieve global elimination by 2020 and sustain it thereafter, particularly by exploiting the opportunity to expand coverage to underserved populations through use of compact pre-filled auto-disable devices.

Displaced, mobile and neglected populations: Existing knowledge on reaching displaced and mobile populations – including individuals escaping conflict zones or natural disasters, economic migrants, seasonal migrants, those moving to urban centres, and traditional nomadic communities – and other neglected populations should be synthesized to identify good practice, innovative new approaches and gaps in knowledge.

Acceptance and demand: Each country should develop a strategy to increase acceptance and demand for vaccination, which should include ongoing community engagement and trust-building, active hesitancy prevention, regular national assessment of vaccine concerns, and crisis response planning.

Civil Society Organizations: Countries should aim to broaden and deepen their engagement with CSOs, expanding the range of CSOs with which they interact and extending their input into areas such as programme planning.

Subsidiary recommendation: 8b. Legal frameworks: A comprehensive global audit should be undertaken to document the ways in which legislation and regulation have been used to promote or undermine immunization at a national level, to identify how legal and regulatory instruments can be best applied in different contexts and for different purposes to strengthen immunization systems.

Technical capacity-building: Through a multidimensional approach, the technical capacity of countries’ immunization programmes should be systematically assessed and strengthened, by leveraging regional and national expertise and opportunities as well as global tools and resources.

Vaccine access: Multidimensional analyses should be undertaken to identify procurement and other programmatic issues affecting timely provision of vaccination, including to the most neglected and remote populations, and used to develop more effective procurement, stock management and distribution plans.

Vaccine supply: Current and anticipated vaccine supply and demand for routinely used vaccines should continue to be mapped and constraints identified, integrating and expanding other relevant ongoing work and focusing on vaccines most at risk of supply shortages.

Middle-income countries: WHO Regional Offices should support middle-income countries in their Regions by leveraging all opportunities to promote the exchange of information, the sharing of lessons learnt and peer-to-peer support.


SAGE was also presented with a selection of indicators for immunization that will be monitored under the Sustainable Development Goals (SDGs) framework, along with an options analysis and the recommendations from the DoV Working Group. SAGE was mindful of the need for ambitious and aspirational indicators which nevertheless allow comparability across time and countries and safeguard country ownership. Hence, SAGE proposed to submit for consideration to the Interagency Expert Group for SDGs the following option for indicator 3.b.1 (proportion of the target population covered by all vaccines included in their national programme): coverage estimates for 4 vaccines, i.e. DTP-containing vaccine third dose, MCV second dose, PCV last dose in the country schedule, and HPV vaccine last dose in the country schedule. For SDG indicator 3.8.1, SAGE proposed MCV second dose as an option for consideration in 2018, which would replace the current indicator which is DTP-containing vaccine third dose. SAGE recognized the opportunity to submit a revised definition (i.e. wording) for indicator 3.b.1 as well as revised metadata to quantify the indicator by 2020.

Finally, SAGE was presented with an overview on the proposed process to develop a global immunization strategy for the next decade (2021–2030). SAGE agreed on the importance of having the strategy adopted by the World Health Assembly in May 2020 and urged WHO to work with all relevant partners from the immunization and the wider public health community towards this objective.
9 See http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/, accessed October 2017.
10 2017 SAGE Assessment Report of the Global Vaccine Action Plan. Available at http://http://www.who.int/entity/immunization/web_2017_sage_gvap_assessment_report_en.pdf?ua=1, accessed November 2017.